MEDICARE: EMANI SANTIAGO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225400000X	Rehabilitation Practitioner		CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1043605264	OTHER	CA	NON-MEDICARE

General Provider Information

NPI Number	:	1619621885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMANI SANTIAGO

Provider Business Mailing Address
First Line	:	42835 SACHS DR
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93536-4812
Country	:	US
Telephone Number	:	661-733-5119
Fax Number	:

Provider Business Practice Location Address
First Line	:	348 E AVENUE K4
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93535-4505
Country	:	US
Telephone Number	:	866-508-0311
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2022
Last Update Date	:	01/28/2026

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Directions to “ EMANI SANTIAGO ” Practice Location

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